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2 New Hampshire Doctors Are On Opposite Sides Of Health Care Divide


Democrats running for president do not agree about health insurance. The question is, should the party expand Medicare just enough to give access to people who want it, or should Democrats try to get rid of private health insurance entirely and create a national health plan that people call "Medicare for All?" All Things Considered co-host Ari Shapiro went to New Hampshire, where people are going to vote in the primary in two months. And in Concord, he met a pair of doctors on opposite sides of this divide.

ARI SHAPIRO, BYLINE: These are not just any two doctors. Randy Hayes and Rob Kiefner have been friends for more than 35 years. They treated patients in the same community before they retired.

ROB KIEFNER: So we continued to be great friends throughout and each other's doctor. And...

SHAPIRO: You were both each other's doctor.

KIEFNER: Yeah. How weird is that (laughter)?

SHAPIRO: Now they are both involved in a progressive New Hampshire activist organization called the Kent Street Coalition. I invited them to Gibson's Bookstore in Concord, N.H., a kind of community gathering place where Kent Street often holds meetings.

KIEFNER: All the candidates show up here for Saturday morning sessions, and this is the True Brew Cafe section of Gibson's.

SHAPIRO: The two of them run Kent Street's health care working group.

KIEFNER: Randy's the co-convener with a capital C, and I'm co-convener with a little C.

SHAPIRO: And you had no hesitation about co-convening with somebody who disagrees with you on the central health care question of the Democratic Party right now.


SHAPIRO: Lots of voters form their opinions about health insurance based on their own experience, whether they have good coverage or not, whether they have medical debt or not. What I found so interesting about these two doctors is that their experience is almost identical. Rob and his wife, who's also a doctor, took over Randy's medical practice. I mean, these two men were each other's doctor. And yet, as the Democratic Party dukes it out over Medicare, these men are in opposite corners of the ring. In one corner, Rob Kiefner.

KIEFNER: I fully support Medicare for All, single payer, publicly financed, privately delivered care.

SHAPIRO: In the other corner, Randy Hayes.

HAYES: I would support Medicare for some, Medicare for more at the drop of a hat, but I am not convinced that the government running the entire billing process at this point is in the best interests of the country.

SHAPIRO: I brought them together so I could try to figure out how two people who line up in so many ways come to opposite conclusions on this key issue. It was a little more civilized than a boxing match. Rob began by telling me he has supported single-payer health care for about 20 years.

KIEFNER: That kind of evolved from my experiences in practice, where I saw people die for lack of insurance. I saw people forgo vital medications for lack of insurance. And I also felt as a physician and as a provider that I was being continually demeaned and snubbed by health insurance companies as they would refuse my recommendation.

SHAPIRO: So you've held this view since long before it was a widely held view in the Democratic Party.

KIEFNER: Exactly, right.

SHAPIRO: And Randy.

HAYES: I, on the other hand, am somewhat more of an incrementalist. I don't see any example in my lifetime where something as financially and ideologically fundamental as the role of government in health care and how we finance it - I don't see any example that suggests to me that this can be a purely top-down reform. I see it as further divisive. I see it as easily demonized by talk radio, particularly among those who make their living dividing our country.

SHAPIRO: Could you each give me a specific example of a patient whose experience convinces you that you hold the right position on this question?

KIEFNER: This is Rob. I'll just given an example of a patient who was a carpenter and self-employed who came in peeing blood, and he had something going on in his urinary tract. And it could have been a stone or could have been a tumor. And the CT scan that we'd have to order, we priced it out. It was going to be $6,000. So he refused to have it.

SHAPIRO: Wow. And what happened to him?

KIEFNER: Eventually, it cleared up. And so he probably did have a stone, but he was not willing or able, for that matter, to come up with those funds to pay for that test.

SHAPIRO: Randy, do you want to weigh in on that scenario?

HAYES: I think that when you talk about a test being denied, you talk about a system that can be easily fixed.

SHAPIRO: For example, he says the Affordable Care Act fixed a lot of problems by making mental health care an essential benefit. He describes treating a patient with complicated mental illness.

HAYES: I was able to get integrated care where I was speaking with the therapist who was practicing under the same roof as I was. I was able to consult psychiatry and modify the treatment plan. So in that regard, it didn't take a total redo of the system but a better alignment of incentives. I totally am open to an increased role for government. I'm just pushing for an incremental approach. As we move forward, we keep one foot in our current experience and one foot in our future aspirations, and we see if we can gradually come to a program that nearly half of the country doesn't consider to be evil.

SHAPIRO: Could I actually just ask Rob to respond to that?

KIEFNER: Yeah. I would respond to that by saying that Medicare for All is actually, though its publically financed, is privately delivered care, unlike a system like the National Health Service in Britain, where the government owns the doctors, the hospitals, every aspect of the care. So it's not like the government has a hand in determining everything that happens with a patient. I would much rather have a not-for-profit entity managing my care than a for-profit entity. I know where the motivations are.

SHAPIRO: This conversation went on for almost an hour. And at the end, they didn't seem frustrated or angry. In fact, these two old friends seemed excited to have the debate. Here's how Randy put it.

HAYES: I think you see movement, and you see this blend of practicality and idealism from both sides. And I don't envy anyone who's trying to write a Democratic platform, but I would encourage them to listen carefully. And I love the idea of probing the relationship between progressive values and policy because that stew is essentially spiced with practicality and electability. Unless we address the whole stew, we're going to be left in a dire strait for the next four years.

SHAPIRO: And with that, the two doctors, Randy Hayes and Rob Kiefner, finished their coffee and went back out into the New Hampshire snow.


KING: That's All Things Considered co-host Ari Shapiro.

(SOUNDBITE OF GLOWWORM'S "CONTRAILS") Transcript provided by NPR, Copyright NPR.

Ari Shapiro has been one of the hosts of All Things Considered, NPR's award-winning afternoon newsmagazine, since 2015. During his first two years on the program, listenership to All Things Considered grew at an unprecedented rate, with more people tuning in during a typical quarter-hour than any other program on the radio.